Here’s an interesting Dilemma for you to ponder over.
I was working on the Rapid Response car, and had been dispatched to a local private care nursery for a 17 month old girl who had reportedly had a fit, and felt very hot. The initial information on the computer screen told me that she had now stopped fitting and was not a known epileptic.
I arrived on scene within a few minutes and found the girl to be conscious, alert, good colour, moving all four limbs and making eye contact.
The staff on scene had contacted the mother who had arrived just before me (she worked just around the corner; it’s not another NHS horror story about our alleged response times!). She was visibly upset and obviously very concerned. The staff member looking after the child gave a really good description of a grand mal seizure event lasting less than 1 minute. She stated that before going into the fit, she noticed that the child felt very hot to touch and once the fit started, she removed most of her clothing and cooled her down.
As I assessed her, she didn’t feel hot to touch any more, but unfortunately the thermometers we use were not working either so I had to go by touch. General examination showed nothing remarkable. No rashes, no obvious signs of infection, no evidence of any significant signs to worry me. Mum stated that her daughter had a similar episode nearly a year ago which was again put down to a febrile convulsion and no further investigations were done.
As I look at the child and see a relatively happy looking toddler in front of me, I have a number of options open to me.
The first set of options I dismiss straight away; those are the ones where the child doesn’t go to hospital. This could be either referring onto her own GP for an appointment today, or leaving the child with mum to keep an eye on and give them some self care information and advice to call back if any further problems or concerns. In this case, there is no way that I would leave a child without medical assessment following a seizure without a known pre existing diagnosis of epilepsy.
This then leaves the options of:
- Mum transports child up to the hospital in her own care with a referral report form from me
- I take Mum and child up to hospital in the Rapid Response car, thereby continuing my ‘episode of care’ until handover at the hospital
- Call for an ambulance and let them transport the child and mother to the hospital, after a handover from me.
Remember that this child appears to be fully recovered and showing no significant effects of whatever event has just happened.
What would you do? How would you manage this patient and facilitate her follow up care?